JOB DESCRIPTION

The Risk Adjustment Coding Specialist will be responsible for the chart review and ICD-9 / ICD-10 diagnosis coding of risk adjustment eligible members, including Medicare, Commercial Exchange, and Medicaid lines of business. This position will have responsibility to assist with audits (ex. RADV), chart retrieval coordination, tracking and trending of coding and documentation issues, and development of targeted provider education. This position will work closely with the Risk Coding and Education Specialist and the Risk Adjustment Audit Specialist to manage diagnosis code changes and processes related to risk adjustment, and develop best practices for medical record review and diagnosis code abstraction.

Minimum of three (3) years in an HMO, Managed Care Organization or in a health care setting is required. *

Demonstrated knowledge of medical record review and diagnosis coding within the health insurance industry is required. Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred. *

Demonstrated ability to research, analyze and interpret CMS and State coding and documentation guidelines and apply to chart review, coding, and auditing. *

Demonstrated ability to participate in project/initiatives that are code or code auditing related. *